Health

Color Doppler ultrasound imaging in iatrogenic arterial injuries

Article Abstract:

There has been an increase in the number of diagnostic and therapeutic procedures performed through access to a major artery, balloon catheter procedures and aortic valve reconstructions to name just a few. These procedures require insertion of fairly large instruments through an artery (usually the common femoral artery in the thigh). Consequently, there is potential for iatrogenic (caused by a physician) injury to the involved artery, particularly false aneurysms (dilatation of a vessel resembling an aneurysm). It is important to be able to differentiate between pulsating hematomas (swelling or mass of blood caused by a break in a blood vessel) and pseudoaneurysms; pseudoaneurysms require surgical repair whereas hematomas do not. Angiography (X-ray examination of the blood vessels following injection with radiopaque dye) may be used, but this procedure is invasive and carries the risks of an adverse reaction to the dye and a second arterial injury. A study was undertaken of 27 patients with pulsatile masses following various intra-arterial procedures, including coronary angiography, balloon angioplasty and aortic valvuloplasty. Color Doppler is an ultrasound technique used to monitor the behavior of moving structures such as blood flow. It provides better discrimination than duplex spectral analysis. Color Doppler successfully identified 23 pseudoaneurysms, which were confirmed on surgical exploration. There were five cases of arterial hematoma with pulsation identified; all resolved during follow-up. There were no false negative or false positive results; both sensitivity and specificity were 100 percent, meaning that both conditions were correctly identified in all cases. These results demonstrate that color Doppler ultrasound imaging is an excellent method of diagnosing arterial injury, in particular pseudoaneurysms, following intra-arterial procedures. (Consumer Summary produced by Reliance Medical Information, Inc.)

Unilateral aortofemoral bypass: a safe and effective option for the treatment of unilateral limb-threatening ischemia

Article Abstract:

Blockage of the aorta (main trunk of the systemic artery) or iliac artery in the lower trunk of the body can result in ischemia (local and temporary deficiency of blood supply) severe enough to threaten the viability of the leg. Even if this occurs in only one leg, bilateral revascularization surgery - bypass graft - to restore blood supply is usually recommended. It is believed that the leg without symptoms will eventually require surgery as a result of disease progression, and several studies have reported that unilateral bypass grafts do not remain open and viable (patent) as long. A report is presented of 42 patients who underwent unilateral aortofemoral bypass graft to determine if unilateral surgery is safe and effective. All patients underwent surgery in an effort to save the leg; 43 percent had gangrene or nonhealing foot ulcer and 40 percent had leg pain at rest. Eleven patients (26 percent) also had bypass graft performed for the lower femoral (thigh) artery. Two patients (5 percent) died from heart attacks within a month of surgery. Overall patient survival at five years was 48 percent. The five-year primary graft patency rate was 74 percent and the percentage of limbs saved was 84 percent. Only 7 percent of the patients required femoral-to-femoral bypass after surgery. These findings show that unilateral aortofemoral bypass is safe and effective; that routine bilateral bypass may be unnecessary; and that unilateral aortofemoral bypass may facilitate vascular bypass procedures below the groin level that may be necessary in some patients. (Consumer Summary produced by Reliance Medical Information, Inc.)